Nothing more than feelings?

Current Psychiatry. 2005 July;04(07):77-91

July 1, 2005|Current Psychiatry

David Krassner, MD;Robert Hierholzer, MD;Matthew Battista, PhD

A psychiatrist becomes morally outraged while hearing a convicted pedophile’s story. How can the therapist confront his emotions without compromising the evaluation?

Stone et al¹⁰ draw several germane conclusions:

Sentencing laws are often unclear or do not take into account scientific research on pedophilia. For example, psychological testing often is not ordered before a treatment is mandated, even though knowing the patient’s psychological profile and the nature of his predilections are crucial to treatment and prognosis.¹²
Many laws do not suggest an instrument of implementation. For example, most laws that mandate a patient evaluation do not specify whether a licensed psychiatrist, psychologist, or other clinician should evaluate the patient.
Many laws directed against pedophilia are punitive in nature. Mandated treatment—or the informed consent that precedes it—is often inadequate,¹⁰ and physicians can be held liable in either case. However, we could not determine the liability that could result from enhancing a convicted pedophile’s libido.

REFERRAL: TREATMENT ADVICE

We referred Mr. V back to his primary care physician and advised the doctor to:

discuss the testosterone treatment request with physicians who treated Mr. V at the state prison
call our hospital’s attorney to investigate the legal implications of treating Mr. V.

We also recommended against enhancing Mr. V’s libido, given his poor insight and denial and the primary care physician’s lack of expertise in this treatment. A recent check of Mr. V’s electronic record indicated that he was not given medication to enhance sexual performance.

Related resources

Sex offenders get Medicaid-paid Viagra. Associated Press May 22, 2005. https://msnbc.msn.com/id/7946129/.
Conte JR, Wolf S, Smith T. What sexual offenders tell us about prevention strategies. Child Abuse Negl 1989;13:293-301.
U.S. Department of Justice, Bureau of Justice Statistics. Statistics on sex offenders and victims. www.ojp.usdoj.gov/bjs/abstract/saycrle.htm.

Drug brand names

Goserelin • Zoladex
Leuprolide • Eligard, others
Medroxyprogesterone acetate • Depo-Provera, others
Nafarelin • Synarel
Sildenafil • Viagra
Triptorelin • Trelstar Depot

Acknowledgment

The authors thank Cynthia Meyer, chief librarian, VA Hospital, Fresno, CA, for her help with researching this article.

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

References

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